Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 1751 | NM |
NPI | 1003087974 |
---|---|
Provider Name | Leonard Tischler |
First Address | Santa Fe, NM 87505-3344 |
Second Address | Santa Fe, NM 87505-3344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2008 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1751 | STATE LICENSE NUMBER (01) | NM |